减少二甲双胍和阿司匹林不适当处方的仪表盘：基层医疗哨点网络中的质量保证计划。

Dashboards to reduce inappropriate prescribing of metformin and aspirin: A quality assurance programme in a primary care sentinel network.

作者信息

de Lusignan Simon, Hinton William, Seidu Samuel, Mathew Mekha, Feher Michael D, Munro Neil, Joy Mark, Carinci Fabrizio, Hobbs F D Richard, Khunti Kamlesh

机构信息

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.

出版信息

Prim Care Diabetes. 2021 Dec;15(6):1075-1079. doi: 10.1016/j.pcd.2021.06.003. Epub 2021 Jun 17.

DOI:10.1016/j.pcd.2021.06.003

PMID:34147402

Abstract

AIMS

To pilot two dashboards to monitor prescribing of metformin and aspirin according to the National Institute for Health and Care Excellence (NICE) 'Do-Not-Do' recommendations.

METHODS

This quality assurance programme was conducted in twelve general practices of the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. We developed dashboards to flag inappropriate prescribing of metformin and aspirin to people with type 2 diabetes mellitus (T2DM). In Phase 1, six practices (Group A) received a dashboard flagging suboptimal metformin prescriptions in people with reduced renal function. The other six practices (Group B) were controls. In Phase 2, Group B were provided a dashboard to flag inappropriate aspirin prescribing and Group A were controls. We used logistic regression to explore associations between dashboard exposure and inappropriate prescribing.

RESULTS

The cohort comprised 5644 individuals (Group A, n = 2656; Group B, n = 2988). Half (51.6%, n = 2991) were prescribed metformin of which 15 (0.5%) were inappropriate (Group A, n = 10; Group B, n = 5). A fifth (17.6%, n = 986) were prescribed aspirin of which 828 (84.0%) were inappropriate. During Phase 1, metformin was stopped in 50% (n = 5) of people in Group A, compared with 20% (n = 1) in the control group (Group B); in Phase 2, the odds ratio of inappropriate aspirin prescribing was significantly lower in practices that received the dashboard versus control (0.44, 95%CI 0.27-0.72).

CONCLUSIONS

It was feasible to use a dashboard to flag inappropriate prescribing. Whilst underpowered to report a change in metformin, we demonstrated a reduction in inappropriate aspirin prescribing.

摘要

目的

试用两个仪表盘，根据英国国家卫生与临床优化研究所（NICE）的“不要做”建议来监测二甲双胍和阿司匹林的处方情况。

方法

该质量保证项目在牛津皇家全科医师学院（RCGP）研究与监测中心（RSC）网络的12家普通诊所开展。我们开发了仪表盘，以标记出2型糖尿病（T2DM）患者中二甲双胍和阿司匹林的不适当处方。在第一阶段，6家诊所（A组）收到一个仪表盘，用于标记肾功能减退患者中次优的二甲双胍处方。另外6家诊所（B组）为对照组。在第二阶段，B组收到一个用于标记不适当阿司匹林处方的仪表盘，A组为对照组。我们使用逻辑回归来探索仪表盘暴露与不适当处方之间的关联。

结果

队列包括5644名个体（A组，n = 2656；B组，n = 2988）。一半（51.6%，n = 2991）的人开具了二甲双胍，其中15人（0.5%）的处方不适当（A组，n = 10；B组，n = 5）。五分之一（17.6%，n = 986）的人开具了阿司匹林，其中828人（84.0%）的处方不适当。在第一阶段，A组50%（n = 5）的人停用了二甲双胍，而对照组（B组）为20%（n = 1）；在第二阶段，与对照组相比，收到仪表盘的诊所中不适当阿司匹林处方的比值比显著更低（0.44，95%置信区间0.27 - 0.72）。